Warning: Do not attempt this at home
On previous posts we discussed the location and indications
for removing the adenoids. For this
entry we’ll discuss the technique for adenoid removal for those whose burning curiosity
is preventing them from sleeping.
Often a procedure done in children, an adenoidectomy (note:
“-ectomy = “removal” in medical terms) typically is a relatively short surgery.
First of all, this is done under general anesthesia, which
means the child is completely asleep. An
anesthesia provider places a breathing tube to delivery anesthesia gases and
oxygen, and this tube also serves to protect the airway during the surgery. The tube could be an endotracheal tube (which
passes through the vocal cords of the larynx and into the trachea—or windpipe)
or a laryngeal mask, which is a tube covered with a soft inflatable device that
covers the top of the larynx rather than passing through it. In either situation, your child is asleep
before this is done. I’ll refer to
either device as a “breathing tube.”
Once the child is safely under anesthesia and the airway is
secure, the surgeon opens the child’s mouth with a retraction device that
pushes the tongue and breathing tube down, inserts a soft catheter into the
nose, pulling it through the mouth in order to elevated the soft palate and
uvula. This improves the view of the
adenoids which are visualized with a mirror held by the surgeon. By the way, I (and most surgeons) sit above
the patient’s head, such that the mouth and throat are viewed upside down. Otherwise, viewing it in the conventional
sense would require me to site on the kid’s chest, straddling the poor
youngster, which not only is awkward, but could land me in jail, so I was told.
Once a good view is obtained (see drawing above), a variety of devices to remove
the adenoids can be used while visualizing the site through the mirror. The older techniques included a variety of
curettes or adenotomes which cut or scraped the adenoids out. A pack is then placed to control bleeding
(called achieving “hemostasis” in medical terms) and afterwards bleeding is
controlled by electrocautery; older techniques used a variety of chemical
cauterizing agents.
 |
| Adenoid currettes |
 |
| Coblation device |
Many surgeons nowadays use a technique called cold ablation
(coblation) which actually irrigates the site with saline solution (salt and
water similar to the body’s serum composition) as the adenoid is ablated and
removed. The adenoid tissue is
essentially cauterized as it is being simultaneously suctioned up with the
saline resulting in a more controlled, layer by layer removal of the adenoid
tissue with far less bleeding. This
technique has rather revolutionized adenoidectomies, which otherwise was a
relatively barbaric procedure compared to the other surgeries ENT docs due that
require more finesse.
At the conclusion of the procedure there is another check to
insure there is no further bleeding. The
anesthesiologist then starts to awaken the child, and once the child starts breathing
on her/his own and the anesthesia provider safely removes the breathing tube, the
child is moved to the recovery area.
Once the child is more awaken, he/she can start taking fluids or ice
chips and later soft foods. This is done
slowly to see how the child tolerates the diet, which we call “advancing the
diet.”
Unlike a tonsillectomy which is considerably more painful,
the child can start a normal diet later that day or the next since food will
not rub against the surgical site. Oftentimes,
the child only needs over-the-counter pain medications such as acetaminophen (Tylenol)
or ibuprofen (Motrin, Advil, etc) for pain and usually for a few days. Sometimes the child might have ear pain since
the adenoids are near the Eustachian tubes.
Bad breath, postnasal drainage and throat clearing are common for 1-2
weeks, so don’t fret about these. Postoperative
bleeding, though possible, is typically rare and much less compared to a
tonsillectomy (which has about a 1-2 % incidence of bleeding after surgery). I usually request the child not do any heavy
exertion (ie, no rough-housing, play structures, heavy lifting, trampolines, or
sports) for about 1 1 ½ -2 weeks, but this might be considered over-cautious
with other surgeons.
So now that your curiosity is satisfactorily quenched, go to
bed and get a good night’s sleep.
©Randall S. Fong, M.D.
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